Cost Absorption
Whether it's a prescription, care degree, care box, rollator, care bed, CPAP, bathroom conversion or direct purchase: When it comes to medical aids, it's not just about the product, but also the need, supply goal, documentation, and potential payer. ADAM helps to make the next step understandable.
ADAM Cost Compass
Cost coverage rarely depends solely on the product name. Often, the first helpful question is: What is it really about – medical necessity, home care, living environment, or a quick desired solution?
Rollator, wheelchair, CPAP, walking aid, certain bath and toilet aids
Health insurance, prescription or referral, medical aids supply
Nursing aids, nursing bed, positioning, care facilitation, consumables
Long-term care insurance fund, care degree, application or consultation
Bathroom conversion, door widening, permanently installed ramp, stairlift
Home environment improvement measure, long-term care insurance fund, application
Higher-quality model, accessories, immediate self-procurement, comfort features
Self-purchase, extra costs, or consultation
Prepare your request effectively
An assistive device can have very different cost implications. These five points help to prepare your inquiry effectively.
Does it concern treatment, disability compensation, easier care, hygiene, consumables, or the living environment?
What exactly is difficult: Walking, showering, standing up, breathing, repositioning, nursing care in bed, or care at home?
Health insurance, long-term care insurance, private insurance, private purchase, or in special cases, another provider.
Prescription, order, care level, HMV number, cost estimate, discharge letter, or description of the daily situation.
In the case of statutory aid provision, contractual partners, health insurance audits, and potential additional costs can play a role.
Extra Cost Trap Check
Many problems do not arise from the tool itself, but from the order, documentation, or false expectations. These points will help with the preparation.
For many supply routes, it is advisable to clarify before procurement whether a prescription, application, or approval is required.
A blueprint is important, but it doesn't automatically mean that every implementation or model will be adopted.
If a model exceeds what is necessary, additional costs or self-purchase may become relevant.
Health insurance and long-term care insurance are not the same thing. Correct classification can save time and queries.
Consumable nursing aids should be selected to suit the specific care situation, not just a standard box.
Guidance without cost commitment
The following overview is a guide. Which approach is suitable depends on the requirements, documents, health insurance, and individual assessment.
Frequently health insurance with prescription or referral
Long-term care insurance fund for care level and home care
Depending on the purpose: health insurance fund, long-term care insurance fund or advisory service
Depending on the aid and need, health insurance, long-term care insurance, or self-purchase
Possible improvements to the living environment for people with care needs
Additional costs or self-purchase possible
Own path through the long-term care insurance fund
Consumable care aids are a separate cost category. They are not the same as standard medical aids covered by health insurance.
When there is a care level and home care, a monthly amount of up to €42 may be relevant.
For this, an application to the long-term care insurance fund is usually required, not a normal medical prescription.
Typical products include, for example, disposable gloves, disinfectants, protective materials, and bed protectors.
The selection should match the actual care situation.
The ADAM Care Box Configurator helps to clearly prepare for your needs.
Home environment improvement
Bathroom modifications, door widening, ramps or stairlifts are often not simple product questions. In such cases, measures to improve the living environment may be relevant.
Important Orientation
Prepare practically
The more clearly the requirements, documents, and everyday situations are described, the better the next step can be prepared.
Often important for medically necessary aids and health insurance coverage.
Relevant for nursing aids, care packages, long-term care insurance, and home environment issues.
What is specifically difficult: walking, showering, getting up, breathing, positioning, or personal care?
The inclusion of a product in the directory of assistive devices does not solely determine coverage.
Helps with time-critical care after a hospital stay, rehabilitation, or a new diagnosis.
Can be helpful with topics regarding the bathroom, bed, transfers, ramps, hoists, or the living environment.
ADAM cost path
You don't need to know right away which health insurance provider is responsible. Describe the need, prescription, care level, or daily situation – ADAM will help prepare the next step.
Describe the situationName a product, recipe, care level, or everyday situation.
Pre-sort by cost centerClassify by health insurance, long-term care insurance, self-purchase, care box, or home environment.
Complete the documentationPrepare prescription, care level, measurements, photos, doctor's order, or cost estimate.
Start next stepSubmit prescription, consultation, care box, direct purchase, or inquiry.
Choose a suitable introduction
Choose the entry point that best matches your current request.
Brief answers for guidance. A binding review always depends on requirements, documentation, health insurance, and individual circumstances.
No. The deciding factor is whether the aid is necessary in the specific case and which method of provision is appropriate. General everyday items are excluded from statutory coverage for medical aids.
A prescription can be important, but it does not automatically guarantee coverage for every cost or every desired model. Depending on the aid and the health insurance provider, verification, approval, or a cost estimate may be required.
For many medical aids covered by statutory health insurance, a co-payment of 10 percent currently applies, with a minimum of 5 euros and a maximum of 10 euros, though not exceeding the actual costs. Different rules may apply to consumables, exemptions, or preferred models.
The health insurance fund is frequently responsible for medically necessary aids. The long-term care insurance fund may be relevant in cases involving a care level, home care, nursing aids, or living environment issues.
The long-term care insurance fund can become relevant when a care level has been assigned and it concerns home care, care aids, a care box, technical care aids, or home environment improvements.
For care level and home care, certain consumable care aids of up to 42 euros per month may be relevant. An application to the long-term care insurance fund is required for this. The selection should be appropriate for the actual care situation.
An assistive product number can classify a product in the directory of assistive products. However, it does not solely determine whether there is an entitlement to coverage in a specific case.
Additional costs may arise if a preferred model or equipment is chosen that goes beyond what is medically or legally required.
This depends on the aid and the health insurance provider. In many cases, it makes sense to clarify the prescription, cost estimate, or application before obtaining the item.
Then it should be checked why it was rejected, whether documents are missing, or whether another form of care is an option. ADAM cannot provide legal advice, but can assist with the technical assessment of the need for assistive devices.
No. ADAM cannot guarantee coverage of costs. We help to clearly prepare the requirements, documentation, product area, and the next step.
Personal Support
Briefly describe your situation: assistive devices, prescription, care level, care box, or everyday situation. ADAM helps to clearly classify the potential care pathway and prepare the next step.
Careful. Clear. Without cost promises.
